Wednesday, 7 April 2010

DIGITAL REMOVAL OF FECAL IMPACTION

Fecal impaction—a large, hard, dry mass of stool in the folds of the rectum and, at times, in the sigmoid colon—results from prolonged retention and accumulation of stool. Common causes include poor bowel habits, inactivity, dehydration, improper diet (especially inadequate fluid intake), the use of constipation-inducing drugs, and incomplete bowel cleaning after a barium enema or barium swallow. Digital removal of fecal impaction is used when oil retention and cleansing enemas, suppositories, and laxatives fail to clear the impaction. It may require a physician's order.
This procedure is contraindicated during pregnancy; after rectal, genitourinary, abdominal, perineal, or gynecologic reconstructive surgery; in patients with myocardial infarction, coronary insufficiency, pulmonary embolus, heart failure, heart block, or Stokes-Adams syndrome
P.100

(without pacemaker treatment); and in patients with GI or vaginal bleeding, hemorrhoids, rectal polyps, or blood dyscrasias.
Equipment
Gloves (two pairs) • linen-saver pad • bedpan plastic • disposal bag • soap • water-filled basin • towel • water-soluble lubricant • washcloth.
Implementation
  • Explain the procedure to the patient and provide privacy.
  • Position the patient on his left side and flex his knees to allow easier access to the sigmoid colon and rectum.
  • Drape the patient, and place a linen-saver pad beneath the buttocks to prevent soiling the bed linens.
  • Put on gloves, and moisten an index finger with water-soluble lubricant to reduce friction during insertion, thereby avoiding injury to sensitive tissue.
  • Instruct the patient to breathe deeply to promote relaxation. Then gently insert your lubricated index finger beyond the anal sphincter until you touch the impaction. Rotate your finger gently around the stool to dislodge and break it into small fragments. Then work the fragments downward to the end of the rectum, and remove each one separately.
  • Before removing your finger, gently stimulate the anal sphincter with a circular motion two or three times to increase peristalsis and encourage evacuation.
  • Remove your finger and change your gloves. Then clean the anal area with soap and water, and lightly pat it dry with a towel.
  • Offer the patient the bedpan or commode because digital manipulation stimulates the urge to defecate.
  • Place disposable items in the plastic bag, and discard the bag properly. If necessary, clean the bedpan and return it to the bedside stand.
  • Wash your hands.
Special considerations
If the patient experiences pain, nausea, rectal bleeding, changes in pulse rate or skin color, diaphoresis, or syncope, stop the procedure immediately and notify the physician.
Complications
Digital removal of fecal impaction can stimulate the vagus nerve and may decrease heart rate and cause syncope.
Documentation
Record the time and date of the procedure, the patient's response, and stool color, consistency, and odor.